Provider Demographics
NPI:1669722427
Name:PEREZ, WILMA
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MACE AVE
Mailing Address - Street 2:APT. 9
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5929
Mailing Address - Country:US
Mailing Address - Phone:718-882-2111
Mailing Address - Fax:718-882-2166
Practice Address - Street 1:1500 MACE AVE
Practice Address - Street 2:APT. 9
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5929
Practice Address - Country:US
Practice Address - Phone:718-882-2111
Practice Address - Fax:718-882-2166
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator